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In a recent study, reported rates on emergency department utilization for hypertensive disorders of pregnancy and the postpartum period were higher in 2020 than 2006, with rates especially high among non-Hispanic Black, Hispanic, and Asian patients.

Increase in ED visits for hypertensive disorders from 2006 to 2020 reported

New research shows fezolinetant significantly reduces the frequency and severity of hot flashes in Hispanic women, offering a safer alternative to hormone replacement therapy.

Safety and efficacy of fezolinetant proven in Hispanic women

Fezolinetant offers women a groundbreaking, non-hormonal solution to manage menopause symptoms like hot flashes and sleep disturbances, supported by large clinical trials.

How fezolinetant revolutionizes non-hormonal menopause therapy

A new study highlights gestational hypertension as a significant predictor of cardiovascular disease in menopausal women, challenging previous assumptions about preeclampsia’s role.

Pregnancy disorders linked to cardiovascular disease in menopausal women

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Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

1rem

Authors

In recent years, clinical assisted reproduction techniques (ART) are increasingly being practiced worldwide, which in turn has led to an accumulated surplus of cryopreserved embryos within fertility clinics [1,2].

Can the Difference in Medical Fees for Self and Donor Freeze-thaw Embryo Transfer Cycle

A 27-year-old woman presents with an 18-month history of vulvar irritation. She is otherwise healthy except for episodes of depression. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole. She used oral steroids but developed knee pain. Tacrolimus has not helped. A biopsy revealed lichen simplex chronicus. Immunofluorescent studies were negative.

A 27-year-old woman presents with an 18-month history of vulvar irritation. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole without relief. What's your diagnosis?

Vulvar irritation in a 27-year-old woman

Saying "obstetrician-gynecologist" is a mouthful for most people, and it's probably the most abbreviated specialty in medicine, both spoken and written. However, there doesn't seem to be a consensus on how to pronounce OB-GYN. First, is it the two-syllable "O-B" or the monosyllabic "Ob"? Second, is it "gin" or "gyne" (like "Lyme")? I wonder if you have a preference. I know I do.

Almost nobody says "obstetrician-gynecologist" when speaking about these specialist physicians. But what's the "correct" way to pronounce OB/GYN?

Is It Ob-Gin or Ob-Gyne?

The US Food and Drug Administration (FDA) has issued a warning regarding the risk of fezolinetant (Veozah) to cause rare, serious liver injuries to patients.

 associated with menopause last May, the Astellas Pharma therapy was the first neurokinin 3 receptor antagonist to receive approval for this indication from the FDA. Its approval was supported by clinical efficacy and safety data accrued in the SKYLIGHT trial program, wherein the once-daily, 45 mg pill was assessed in 3000-plus participants for the treatment of VMS.

At the time of its approval, the FDA issued label warning regarding the risk of elevated hepatic transaminase in patients treated with fezolinetant; the agency advised that eligible patients receive a blood work test to assess for liver damage prior to initiating the therapy, followed by routine bloodwork every 3 months for the 9 months of the regimen.

The FDA additionally discouraged the use of fezolinetant in combination with CYP1A2 inhibitors, as well as in patients with cirrhosis, severe renal damage, or end-stage kidney disease.

Now, this week, the FDA published a Drug Safety Communication stating fezeolinetant’s prescribing information label has been updated to address the risk of liver injury on the basis of post-marketing data showing elevated liver blood test values and signs of liver injury in a patient taking the medication for approximately 40 days.

“We also added new recommendations for patients and health care professionals about increasing the frequency of liver blood testing, adding monthly testing for the next 2 months after starting Veozah, and then at months 3, 6, and 9 of treatment as already recommended,” the FDA wrote. “The updated prescribing information also instructs patients to stop the medicine immediately and contact the health care professional who prescribed the medicine if signs and symptoms of liver injury occur.”

Key among the symptoms reported in the patient were abnormal liver enzymes and bilirubin levels, as well as visible signs of liver injury including fatigue, nausea, itching, yellowed eyes and skin, light-colored stool and dark urine. The FDA confirmed the symptoms gradually receded and blood test values improved once the fezolinetant regimen was stopped.

A number of individual demographic and clinical factors may impact one’s risk of liver injury due to fezolinetant, the FDA wrote; as such, the agency cannot determine the likelihood of one experiencing these adverse events due to the therapy. They advised that patients communicate with their prescribing clinicians regarding the benefit – risk profile of fezolinetant. Clinicians are reminded to report adverse events associated with the drug to the FDA’s MedWatch program.

Astellas Pharma has responded to the FDA's warning, stating, "We are committed to ensuring the hepatic laboratory testing protocol in the VEOZAH US prescribing information identifies patients at risk for or experiencing symptoms of potential drug-induced liver injury as early as possible and therefore have added 2 additional timepoints for hepatic tests to the label, testing for an additional liver value, as well as guidance on when to seek medical attention and when to discontinue VEOZAH." See sidebar for the company's full statement. 

US Food & Drug Administration. FDA adds warning about rare occurrence of serious liver injury with use of Veozah (fezolinetant) for hot flashes due to menopause. FDA Drug Safety Communication. Published September 12, 2024. Accessed September 13, 2024. https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-warning-about-rare-occurrence-serious-liver-injury-use-veozah-fezolinetant-hot-flashes-due?utm_medium=email&utm_source=govdelivery

Petronelli M. FDA approves fezolinetant for vasomotor symptoms. 

. Published May 12, 2023. https://www.contemporaryobgyn.net/view/fda-approves-fezolinetant-for-vasomotor-symptoms

The FDA upped the recommended rate of liver blood tests for patients initiating fezolinetant on the basis of a post-marketing case report involving serious liver injury.

Clinical

FDA updates warning for liver injury due to fezolinetant

These are 3D ultrasound images of a 14-week fetus. What is your diagnosis?

occipital meningocele and umbilical hernia

DailyDx: 3D Images of a 14-week fetus

A recent study suggests that women who experience physical intimate partner violence may face a faster decline in working memory performance, a cognitive function essential for tasks such as recalling a phone number, according to study authors. These findings were presented at the 2024 Annual Meeting of The Menopause Society in Chicago, from September 10-14.

Memory impairment is often seen as a natural part of aging. However, this study highlights how certain factors, such as intimate partner violence, can exacerbate the decline. According to the research, 1 in 3 women will experience some form of intimate partner violence in their lifetime, which can have significant short- and long-term health effects, such as impaired cognitive function

The study, which included data from more than 1,700 participants in the Study of Women's Health Across the Nation (SWAN), focused on whether physical violence experienced during pre- or early-perimenopause is linked to a steeper decline in cognitive performance. Researchers adjusted their analysis for factors such as race/ethnicity, education, financial strain, depressive symptoms, sleep disturbances, and bodily pain.

Researchers assessed a total of 1,713 women who experienced physical IPV before or during early perimenopause. The study examined scores from 3 cognitive tests: the Symbol Digit Modalities Test, the East Boston Memory Test, and the Digit Span Backwards (DSB) test, with cognitive outcomes assessed 6 times between SWAN follow-up visits 7 and 15.

At the SWAN baseline, 3.1% of participants reported experiencing physical IPV within the prior year. After adjusting for variables such as race/ethnicity, education, financial strain, depressive symptoms, sleep disturbances, and bodily pain.

The findings revealed that women who reported experiencing physical violence in the year before their SWAN baseline interview exhibited a significantly greater decline in working memory over time, compared to those who had not experienced such violence. These results align with previous research, according to the authors, reinforcing the association between intimate partner violence and negative cognitive outcomes.

"This analysis underscores the importance of further research into intimate partner violence, which may be an under-recognized source of unfavorable cognitive aging," said lead researcher Jillian Baker, MPH, BA, a PhD student from the University of Michigan.

Stephanie Faubion, MD, MBA, medical director of The Menopause Society, also emphasized the importance of these findings. "It's important for healthcare providers to understand the association between physical violence and mental health," she said. " The high incidence of intimate partner violence should further prompt healthcare professionals to open the conversation about this sensitive issue with their patients."

Baker J, Greendale GA, Hood MM, Karlamanga AS, Harlow SD. Experiences of physical intimate partner violence and longitudinal cognitive performance in midlife women: findings from the Study of Women’s Health Across the Nation (SWAN). Presented at: 2024 Annual Meeting of The Menopause Society. Chicago, Illinois. September 10-14, 2024.

A study presented at the 2024 Annual Meeting of The Menopause Society, found that women who reported physical intimate partner violence also demonstrated decreased working memory performance over time.

Physical intimate partner violence linked to decreases in cognitive performance

A new study revealed that women veterans with probable post-traumatic stress disorder (PTSD) are twice as likely to experience early menopause and its associated health challenges. The findings, which are being presented at the 2024 Annual Meeting of The Menopause Society in Chicago from September 10-14, highlight the long-term physical consequences of PTSD in female military personnel, particularly those who served in the Persian Gulf War.

The study, which included over 2,000 women veterans, sought to understand the relationship between military exposure and early menopause. Researchers focused on whether the stressors these women experienced could lead to premature ovarian aging, as well as an increased menopause symptom burden. Early menopause, which occurs before the age of 45, can have serious health implications, including fertility loss, higher risk of cardiovascular disease, osteoporosis, sexual dysfunction, depression, and even premature death.

The study concentrated on Persian Gulf War (GW) women veterans, whose unique experiences—such as exposure to burn pits, oil fires, and the associated Gulf War Illness (GWI)—are linked to various health issues. GWI is characterized by joint pain, gastrointestinal issues, headaches, and rashes, alongside mood disturbances. These health problems, combined with psychological stressors like military sexual trauma (MST), have compelled researchers to explore whether such factors contribute to early menopause.

The Gulf War Longitudinal Study, conducted by the VA Office of Health Outcomes Military Exposures, surveyed 2,013 women veterans from both Gulf War-deployed and Gulf War-era cohorts. At baseline in 1995, the average age of participants was 31.39 years, with a majority being non-Hispanic White (61.1%). Of those surveyed, 65% reported environmental exposures, 61% suffered from Gulf War Illness, and 22% experienced military sexual trauma. Additionally, 27% met the criteria for probable PTSD, which was determined by the PTSD Checklist–Civilian Version (PCL-C). The results revealed that just over 5% of participants had experienced early menopause, defined as occurring before age 45 years.

Researchers also found that probable PTSD was strongly associated with early menopause, with an odds ratio (OR) of 1.83 (95% CI 1.13-2.96), meaning that women with PTSD were almost twice as likely to undergo early menopause compared to those without the disorder. Other military-related factors, including Gulf War deployment, environmental exposures, Gulf War Illness, and military sexual trauma, were not significantly linked to early menopause.

Results of the study showed that women veterans with probable PTSD were found to have nearly double the odds of experiencing early menopause. Importantly, there were no significant associations between Gulf War deployment, Gulf War exposures, Gulf War illness, or military sexual trauma and early menopause, suggesting that PTSD itself plays a critical role.

Caitlin Elizabeth Haas, the study’s lead researcher from the San Francisco VA Health Care System, stated, “This work adds to the growing body of literature implicating PTSD in adverse menopause and reproductive health outcomes across the lifespan. One possible explanation is that PTSD is indicative not just of trauma but of symptom burden, possibly prolonging the biological sequalae associated with the stressful event."

Stephanie Faubion, MD, MBA, medical director for The Menopause Society, stressed the need for heightened awareness of these factors in clinical care. "This study, among other things, highlights the need for healthcare professionals to thoroughly review their patients' histories and be aware of any external stressors that could impact their menopause experience and related symptoms.”

Haas CE, Gibson CJ, Cao G, et al. Military Exposures and Early Menopause: Findings from the Gulf War Cohort Study. Presented at: 2024 Annual Meeting of The Menopause Society. Chicago, Illinois. September 10-14, 2024.

Female veterans with PTSD are twice as likely to experience early menopause and related health risks, according to a study presented at the 2024 Annual Meeting of The Menopause Society. 

Boon Chin Heng

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